Stopping Eliquis Before Dialysis Catheter Insertion

Recommended Timing and Special Considerations

For patients with normal renal function, a 48-hour interruption of apixaban is appropriate before dialysis catheter insertion, as apixaban has a half-life of approximately 12 hours and requires 4-5 half-lives for adequate clearance, according to the American College of Clinical Pharmacy 1
Patients with severe renal impairment may have prolonged apixaban clearance, and consideration should be given to extending the interruption period, as suggested by the European Renal Association 2

The American College of Chest Physicians recommends never using bridging anticoagulation with heparin or LMWH when stopping apixaban for dialysis catheter insertion, as this dramatically increases bleeding risk without reducing thrombotic risk 3, 1
Apixaban can be resumed at least 6 hours after the procedure if hemostasis is adequate and there is no ongoing bleeding, though waiting 24-48 hours is prudent for a vascular access procedure, as advised by the American Heart Association 1